Dealing with Grief and Loss

Marty Richards, MSW, LICSWJanuary 21, 2014

Goals:

Explore “normal and complicated” grief Identify “disenfranchised grief” and its effects Learn ways to assist persons to deal with grief and losses

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Loss Transition and Grief:

Older and disabled persons face myriad transitions.Transitions are normative.Grief often accompanies transitions.

Transitions:

“Large” or “small” Affect people in different waysGenerational differences in facing loss and grief

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Factors Affecting Transitions and Grief

Emotional connection to those in transitionBalance of relational expectations and obligationsShock impact

Factors Affecting Transitions and Grief

Timing of the transitionTo whom the change is happeningAdaptability and resiliency

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Transitions and Grief

Cultural differences are present. Each person responds uniquely.Listening is the key skill in accompanying another.

“Normal” Grief

Is “process” not an “event”.Each situation is unique.Losses raise varied emotions.Grieving: a circular process; requires hard work and time.

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Grief Stages

May look like extreme anger.Can appear to be depression.Special concerns are present with dementia.

Grief “Overload”Several losses occurring at the same time or in rapid succession Grief happening to those around a person“Large” and “small” lossesSome obvious, some subtle

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Loss Issues

Losses most often not replaceable“Anniversary” reactionsOthers may think person is “taking too long” to grieve.Persons need time to adjust.

Complicated GriefPerspectives on this vary widely.Persistence of symptoms or separation distress.Feelings of devastation or traumatization by a death/event.

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Unresolved GriefUnresolved losses may resurface.Intense reaction to current loss may signal earlier unresolved grief.“Fallout” from previous situations may occur.

Grief can Masquerade as Other Concerns

AngerDepression

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Grief and DepressionGrief: onset caused by recognized losses; anger openly expressed (may be misdirected)Depression: may not relate to particular loss and anger; may be turned inward

Grief and DepressionGrief: preoccupation with particular loss with resultant guilt; person responds to supportDepression: generalized guilt; support often rejected, self-isolation may occur

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Delayed Reaction

Feelings blocked with no time to process. Multiple losses occurring at the same timeNo permission to grieve at the time of loss

Exaggerated Reactions

Person frozen in one emotion Grief becomes chronicGrief negatively affects daily functioning

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Disenfranchised GriefSocial unacceptability of openly expressing griefGrief from past trauma not explored adequatelyGrief discounted by othersSuppressed grief bubbles up in crisis

Factors in Unresolved Grief

Unexpected sudden deathDeath of child, even as adult Missing bodyLack of “permission to grieve”Not enough time to grieve

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Factors Exacerbating Grief

DementiaLack of support networkOver dependence on deceasedUnresolved conflicts

Factors

Avoidance in expressing emotionsFeeling responsible for the loss in some wayCumulative losses

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Complicating Factors

The loss may be a family secret

“Anticipatory” grief for self or another

Communication About Grief and Loss

Make no assumptions about what the person is feeling.Be aware of non-verbal communication.Hear “symbolic” language.Silence is communication!

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Strategies for Healing

We do not need to have all the answers.Key skill is listeningGive persons the time they need on their particular journey.

Strategies for Healing:Assessment

Supportive network?Possession of useful coping skills?Ability to express feelings?Connection to spiritual support?

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Strategies for Healing

Look for signs of unresolved grief.Help person acknowledge grief.Name feelings.Encourage person to “speak” or be “silent.”

Strategies for Healing

Give “permission” for person to grieve.Be “with” persons non-verbally and with words.Support people in their pain.Don’t “protect” from sadness or dry tears too soon!

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Strategies for Healing

Identify “normalcy” of feelings in dealing with losses, especially anger.Educate person about loss and grief and their effects.Be aware of your own grief issues.

Understand Losses’ Implications

Why were losses important?What do losses mean now? How is person affected physically, emotionally and spiritually by losses?

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Is Forgiveness Work Needed?

Are there real/imagined wrongs connected to loss? From whom is forgiveness needed?Is there need for referral to spiritual advisor?

Differentiate Between Survivor and Deceased

Help persons redefine themselves in context of losses. Support individualization.

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Examine Major Defenses

What has delayed a healing process?Is the loss likely to reoccur?Give permission to share feelings. What events have happened to put person at risk now?

Identify and Process Unresolved Concerns

Explore meaning of death and afterlife for a person.Clarify “unfinished business.”Encourage persons to not make major decisions right after a loss if possible.

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Encourage Positive Future Movement

Support new life when person is ready. Discuss reinvesting emotional energy.Remind that grieving takes time.

Encourage Positive Future Movement

Suggest support groups which may help.Build on person’s strengths and resources.Help persons leave “legacy.” Encourage resilience.

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Support Beneficial Health Processes

Encourage moderation in alcohol or medication.Stress exercise and healthy eating. Support mindfulness and stress reduction.Walk with person in journey.

Assisting Persons Build on Spiritual Strengths

Learn person’s spiritual perspective.Assist in developing rituals. Advocate for person if they have difficulty in advocating for themselves.

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Helping Persons Cope with Grief and Loss

You do not have to have all the answers.Give person time they need to do the grief work. KEEP HOPE.

“Hope Changes”

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“Hope is not about believing that we can

change things. Hope is about believing that we do makes a difference.”

Havel

Four Things That Matter Most

Ira Byock

I forgive you…Please forgive me.”“Thank you.”“I love you.”“Goodbye.”

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